Hello everyone. The following is a detailed piece regarding preparation for the United States Medical Licensing Examination Step 1. I am a final year medical student and I completed my USMLE exam on June 10, 2012; I achieved scores of 99/266.

First I’d like to introduce and investigate some of the misconceptions and prejudices surrounding the USMLE Step 1 examination which seem to be especially prevalent within overseas students

Myth 1: You should only take the USMLE Step 1 exam after graduation.

Verdict: Baseless

the idea that one should wait until after graduation before taking USMLE Step 1 exam is patently false, based on a risk that is no less present when taking the exam after graduating. No matter your level of experience or amount of preparation, Step 1 represents a risk for anyone who undertakes it given the simple fact that it is an unpredictable exam.

The benefit of taking USMLE Step 1 before graduation is that you are still immersed in the detail of your medical education, typically resulting in a score that is substantially higher than when taken post-graduation. This gives you the benefit of relying on still-fresh study habits and medical information that remains fresh in your mind and helping you to find the right tempo to study and prepare, tasks that are often lost in the fray after you enter the medical profession.

Rather than wasting your time during your medical education, spend it reviewing USMLE recommended textbooks in order to prepare for Step 1! Keeping in mind that American students take Step 1 at the end of their second year and Step 2 at the end of their fourth year, waiting until after graduation to take Step 1 can only negatively affect any competitive edge you’ve gained.
Myth 2: You must memorize the Kaplan series and know it by heart.

Verdict: Incorrect and a potential time-waster.

actually what i know for sure is that American medical students are rarely intersted in studying Kaplan in thier USMLE step 1 preparations; the appropriate books on this section of the test are mentioned further on. While Kaplan is an excellent series, the idea that it is the ultimate base for the USMLE Step 1 exam is simply untrue; the Step 1 exam does not have a well-defined syllabus, forcing most students to turn to the syllabus released on usmle.org.

Instead of cramming all of the material into your memory, much of it not found on the exam, it is a good idea to focus on key areas. Replacing the Physiology book with BRS Physiology and replacing Pathology with Golijan (you’ll need to supplement biostatistics with high yield biostatistics) are key ways to replace Kaplan with less time-consuming and far better focused material.

Remember that much of the information contained in Kaplan is vague, especially the Genetics section of Biochemistry, and it is rarely included on the exam. On the other hand, some topics require more study material than is recommended including cancer chemotherapy and lysosomal storage diseases. When it comes to mastering Microbiology, the use of Levinson is crucial..

As mentioned above, American students typically take the USMLE Step 1 exam prior to graduation; if clinical exposure isn’t necessary for students in the United States to be successful in their exams, it is not necessary for students in other countries, either.

While serving in a clinical setting in hospitals will certainly help you to better understand methodology and practices leading to diagnosis, management and treatments, it is definitely not imperative that you have clinical experience before taking the USMLE step 1 exam. Most of the cases the exam will present you with can be easily understood by simply applying the knowledge of basic medical sciences that you’ve acquired through your studies; in-depth topics, such as those of radiographs and gross specimens, can be practiced with resources available freely on the internet and via your university; even the sound of a heart sounds and murmurs can be easily studied with the help of Google!

With patient management scenarios only appearing very rarely in the Step 1 examination, a basic knowledge of medical science is all you need to prepare you; the Step 2 CK examination offers a more in-depth focus on patient management.

Myth Number 4: A good study indicator is “number of reads.”
Verdict: Not necessarily true.

If there is one certainty when it comes to studying it is that each and every person has a unique method that works best for them and this makes the idea that any one style should work for everyone baseless. While more than a single read of the material will certainly be necessary, a rigid sequential study method typically follows the Kaplan series and offers little significant benefit.

I’ve been asked repeatedly by my peers as to how many reads I’ve completed and my answer is always the same: the number of reads is not the best criterion to use when judging one’s preparation – that’s the purpose of the NBME sample assessment. The truth is that you shouldn’t let the idea of the importance of your number of reads dictate how you study; some people study quickly and spend minimal time on each topic, allowing them more time to revise, while others find that an opposite method works best for them.

The above being true, a person who has completed two reads could very well be as prepared as someone who has completed seven; it is also worth noting that some subjects require more reads than other – pharmacology, for example.

So what study method is the best? That’s entirely up to you. Instead of forcing yourself into a rigid “number of reads” dominated method, work within your own already well-developed study habits instead. Always remember: if you scored well on the NBME test then you’re doing well.

Myth 5: If you score below 95 on the USMLE Step Exam, you’re done.

Verdict: Absolutely untrue.

While Step 1 is very important, it is crucial to remember that it is not the only criterion considered when judging a candidate; a well-rounded candidate will be judged on all material, including the Step 2 CK and Step 2 CS exams, electives, research experience and more. Not everyone will score a 99 on the Step 1 exam and there is no need to lose confidence in your abilities if you don’t. Like any exam, Step 1 will present challenges and not every exam can be your best.

If you do face a disappointing score on the Step 1 exam than simply study hard and compensate with Step 2; losing hope will not get you anywhere.

Myth 6: Step 1 focuses only on broad concepts.

Verdict: False; study, and study hard.

Students preparing for the Step 1 exam often work under the idea that it will not require much knowledge of particulars, focusing instead on broader concepts and ideas in preparation for Step 2. This is patently false and all students must realize that there is far more to learn for this exam than was presented in college, all in additional to new concepts. The particulars of Microbiology, Immunology and Pathology alone will demand endless information with the exam disguising many knowledge-based questions with exercises in in multiple-process thinking.

Myth 7: Up to 80% of the Step 1 exam is based on Pathology.

Verdict: False.

While it is true that upwards of 95% of the exam will contain clinical vignettes that can be directly correlated to Pathology, the subject matter contained on the exam will vary from subject to subject. For example, you may be given a vignette on Ataxia-Telegiectasia while being tested on an immunological or molecular biology concept. With the recent change on the USMLE exam to include more clinical vignettes, the variety of knowledge required to do well on the exam is more prevalent than ever.

I would recommend dividing your attention equally among all subjects in order to give yourself a good framework from which to work. There is no rule about topic inclusion and the exam itself is constantly updated to reflect current medical standards, leaving you to decide which subjects are most worthy of your attention.

Myth 8: Delaying the exam will help to increase my score.

Verdict: Potentially false; even the opposite could prove to be true.

While delaying your taking of the exam in order to provide more time for study may seem like an attractive idea when you’re feeling rushed and short on time, it is worth keeping in mind that that month could just as easily lead to a loss of remembered information.

Momentum in serious study is important and momentum can only be maintained with sustained effort towards your exam preparations. Choose your exam date and stick with it, allowing your positive momentum to carry you directly into the exam room and removing all of the risks that come with breaking your academic rhythm.

Myth 9: I’ve heard that Virology is a main focus in Step 1 so I’m focusing my studies there.

Verdict: False; exams are not standardized.

The lack of uniformity in Step 1 exams means that you cannot trust what you’ve heard as it may or may not pertain to your particular exam. Exams vary in content and even scoring method, leaving you in the dark when it comes to guessing about content.

Instead of worrying at the last minute about cramming one particular topic or another, work to split your study time evenly between all major subjects, spending extra time on topics within Pharmacology and Microbiology not because they are likely to appear more often on the exam but because they are more complicated areas of study. This will ensure that you have a firm grasp of each subject and will allow you to avoid the trouble you’ll face when your exam is full of Biochemistry and you’ve spent the past week cramming Virology.

Hello to all MRCP hopefuls out there. I’ve decided to share with you my experience while studying and sitting for the written portion of the MRCP part 2 exam.

I luckily managed to not only pass the MRCP part 2 exam my very first time sitting for it, but to also achieve a respectable score of about 68%. To put this into perspective, the passing score is 55%. I also managed to achieve this score with only 4 months worth of studying. Here is some of advice based on my own personal experience:

1-What to Read:

At the top of the list of required reading material for the MRCP part II exam is none other than the Oxford Handbook for Clinical Medicine. From my point of view, this book is one of the absolute best books you can use to prepare for MRCP exams as a whole, whether you’re studying for part 1 or part 2. This book actually contains the keys needed to answer many of the exams’ questions. However, it does have a disadvantage, which is its large size that can make it different to memorize for many.

Essential Revision Notes: Of utmost importance for both parts of the MRCP exam. These notes are written in a manner that facilitates memorization and focuses on the key subjects that examiners seem to prefer. Unfortunately, these notes contain a considerable amount of inaccuracies and can’t be considered very up-to-date, particularly when it comes to latest updates in treatment and diagnosis so always keep an eye on other more updated sources when you are reading from this book
Complete Data interpretation of the MRCP: An excellent group of books with phenomenal interpretations.
Radiology for MRCP 2: It is important to realize that approximately 15-20% of the written portion of the MRCP part 2 exam consists of picture-based questions. Over half of these are radiology related, ranging in variety from x-rays to CT scans and even MRI or ISOTOPE SCAN questions. Radiology books in general are rather difficult to study and understand. This book however is easy to comprehend and will help you a tackle a weakness many MRCP candidates seem to have.

Rapid Review of Clinical Medicine for MRCP : Part 2:

While I may not have personal experience using this book in particular, it is highly regarded by many MRCP candidates. It is even considered by many as the most essential book needed to pass the written portion of MRCP part 2 exam. In fact, some of my own personal colleagues have relied solely on this book and have managed to achieve impressive results.

2- Online Tuition Courses:

Recently, online MRCP courses have seen an increased interest for all sorts of candidates. In fact, I personally consider the importance of these courses to be greater than the importance of all the books I’ve mentioned combined. Unlike books which set their limits at 200-300 questions per book, using online courses you will be exposed to an incredibly large bank of questions usually around 2000 to 3000 mcqs. Therefore, these courses will give you a much greater opportunity to study and practice. A second advantage these courses give you is the ability to track your progress compared to other candidates and thus they will help you define the areas where your knowledge needs to be fortified. Never underestimate the importance of the great variety of questions offered by these courses, as MRCP part 2 exams tend to repeat these questions whether with or without modification over the years.
My experience with not one, but two of these courses has been extremely positive. These online courses were onexamination and pastest, with the former offering more in terms of questions likely to appear in the exam.

3- With regards to the picture-based questions in the exam, it is advisable to take advantage of the variety of free medical atlases available online, such as dermatlas that offers several thousand photos you can study. However, it is also advisable not to invest too big a portion of your time in this task because compared to the written questions, picture-based questions pertaining to either radiology or ECG are a minority and answering them doesn’t always depend on having an accurate understanding of the pictures.

4- Last but not least is time management. Proper time management is essential to your success and can make or break your chances of getting though the MRCP part 2 exam. You have to keep in mind that most of the questions are long and take time to answer but you should never take too much time answering a single question while neglecting others. I had to deal with this issue myself and while I ran out of time answering the first paper, I managed to stay afloat for the following two papers by saving the most complicated questions for the very end.

I wish you the best of luck and I hope that sharing my experience will provide future candidates with some important tips to pass the MRCP part 2 exam.

mrcp uk exam is a huge step in your medical career and it is a difficult exam only if you did not prepare well and it is actually very passable and straightforward exam if you know how to prepare for it and used the right tools here is some tips

1- give your self good time for preparation say 4 to 6 months if you are not so busy or 8 to 10 month if are a busy doctor and don’t have ample free time for preparation

2- concentrate your initial reading efforts on philip kalra book (essential revision notes for mrcp) and OXFORD HANDBOOK OF CLINICAL MEDICINE these 2 books in my opinion combined with easterbrook book for basic science is more than enough to study for mrcp uk part 1 and the most important thing you have to notice is that you have to buy the latest editions of these books as you are required to have the latest knowledge about diagnosis and management not more 18 months before the actual exam date and as for bigger textbooks like kumar and davidson you can resort to it from time to time to clarify some points only.

3- subscribe to one or two online mrcp revision courses and the best ones in my opinion is onexamination.com and pastest courses which have a huge question bank containing thousands of multiple choice questions that covers all aspects of mrcp curriculum and every question is followed by good explanation and the good thing is many questions is taken from previous exams of MRCP UK part1 and both courses are much better and more comprehensive than all best of five questions books you can find in the market today which is mostly not related directly to questions you will actually have in the real exam

4- in the exam day don’t arrive at exam center so early i mean like 2 hours or something and don’t discuss exam wi

th any other candidate either before the exam or in-between paper one and paper 2 as this will only increase your nervousness.

You know what they say…pass it along…so after my two tries at the Mrcp Paces I finally passed in on the third try. After all that I have learned from this experience I feel I should inform you to help you hopefully from avoiding the pitfalls I fell into. So for what its worth here is some of what I think is important information…

Think before you speak.

Don’t blurt out your answers. Stay calm think about what the examiner is asking then answer calmly.

Presentation and Study go hand in hand.

Don’t lose sight of what the paces exam is focused on which is the common diseases and not the rare diseases as those in the first two parts of the written exams. Follow these steps for this segment…

For the study sector

In respect to the individual branches of the exam study about sixof the most common diseases that are most often found in the exam. Focus all your studies on these paying attention to details.

If you do this you will not be taken off guard by the examiners

Line of questioning.

For the presentation sector

By knowing the most common diseases first you will be able to utilize them when you are questioned about differential diagnosis.

Be alert.

Don’t rush through your inspection like you can’t wait to get it over with. There are clues possibly around your patient area that might assist you in your diagnosis. For example if the patient is a chest case then there may be sputum pots or inhalers close by. Thyroid patients often have a glass of water in the vicinity. Use these as indicators for your diagnosis.

Let go of the past.

When you have completed one station, then forget about it. You need all of your time to prepare for the next one. Clear your thoughts while you focus on the next station especially if this is the communication skills and history taking segment. You are only going to have five minutes to read the clinical evaluation paper. You have to put the key factors of this to memory and compose your conversation that is coming up around this.

Put on a good front.

The last thing you want to do is look nervous or insecure. Confidence in what you are doing paints the right picture of you to the examiner.

Conduct yourself accordingly.

This specifically refers to the client contact. Upon the conclusion of your examination thank the patient then turn away from him. You are now addressing the examiner. Keep your eyes focused on him. The examiner will ask you what you have discovered in your examination. Avoid glancing at the patient. Keep your eyes on the examiner and answer him directly.

Be clear and be heard.

Don’t mumble it shows a sign of insecurity. Don’t yell either. Concentrate on keep your tones as normal speech when conversing with both the patient and the examiner.

Don’t use your imagination.

If you have any doubts about some possible signs you may have observed during your examination don’t mentions them. Only focus on what you are sure of. You don’t want to be expending knowledge on something that isn’t there. This is important as it is better to miss something then fabricate it to the examiners.

Be specific.

Remember your presentation is about the patient at hand and his/her specific condition, not the ailment in general. In others words if the patient suffers from COPD, then talk about the specific criteria that the patient is presenting with this condition. Not the generalities of COPD. For example nebulizers and intravenous antibiotics, and corticosterioid would be the treatment for a patient in exacerbation. So you would focus on this. If your patient were stable then your course of treatment would probably be inhalers, so therefore you would talk about this. In other words talk about your patient and his problem. Not the problem in clinical terms.

Make your patients your best friend.

This is in reference to the purposes of practice. You need to have lots of practice so you are going to be confident in your examination during your presentation. Practice makes perfect so do so every opportunity you can.

Keep your chin up.

At the conclusion of it all don’t second guess yourself. Every examiner is different and have their own acceptances of mistakes and errors. It may be that you made a serious error but balanced against the right things you did it may not fail you. Such was the case for me. Most often it is the overall performance that counts.

Many thanks for the opportunity to share this with you and I am looking forward to returning with more hints of dos and don’ts for paces.